Fertility Care PathUniversal guide · federal

Fertility Care

A complete path through how it works, costs, legal considerations, workplace support, emotional well-being, and the policies that shape your care — with specific next steps for wherever you are right now.

Educational content only — not medical or legal advice. For personal guidance, consult a licensed professional. Last updated April 2026.

This is the federal, universal view of fertility care.

Insurance mandates, parental rights, leave programs, and embryo laws vary state by state. Open your state guide for the specifics that apply to you.

Start here

Understanding fertility care

What it is

The full spectrum of medical support that helps people conceive — from baseline evaluations and hormone support through advanced assisted reproductive technology. Not one treatment, a range of options.

Who it serves

Solo parents, same-sex couples, opposite-sex couples, partnered and unpartnered people of all genders, people facing diagnoses that affect fertility, and anyone who simply wants to understand their reproductive health.

When to explore

ASRM guidance: evaluation after 12 months trying under 35, 6 months at 35–40, right away over 40. You can learn about your fertility health before you are ready to start — knowing your baseline does not lock you into a path.

Key insight · Information-forward

You don't need to be in crisis to learn about your fertility health.

Knowing your baseline does not commit you to any path. Several clinically validated tools give you a snapshot of your reproductive health before you are ready to act on it.

Hormone panelAMH, FSH, estradiol, LH, TSH, prolactin. Ask your OB-GYN or PCP for Day 3 values.

At-home testsModern Fertility (Ro), Everlywell, LetsGetChecked offer CLIA-certified panels reviewed by a physician.

ProovFDA-cleared at-home test confirms ovulation via PdG (progesterone metabolite).

YO Home Sperm TestFDA-cleared motility test. Provides a live motility score, not just count.

Cycle trackingClue, Flo, Premom, Clearblue Digital. Low-effort way to flag irregularities.

Semen analysisIn-clinic SA is the gold standard; repeat at least one month apart per AUA/ASRM.

Peony does not endorse specific products. Tools listed based on available clinical evidence. A fertility specialist may repeat tests in-clinic for a comprehensive evaluation.

Sources & citations

ASRM, "Fertility evaluation of infertile women: a committee opinion" (2021) · ASRM, "Testing and interpreting measures of ovarian reserve" (2020) · ACOG, "Anticipatory Counseling Regarding Ovarian-Factor Fertility Decline" (2025) · AUA/ASRM, "Diagnosis and Treatment of Infertility in Men" (2020, amended 2024).

You're viewing How it works for the fertility care path.

What happens in fertility care — and what you can do right now

Fertility care is the full spectrum of medical support for building your family — from a first hormone panel all the way through advanced treatment. You don't need a diagnosis or a specific timeline to start.

Start with your baseline

You don't need a failed cycle or a specific timeline to understand your fertility health. A hormone panel and a semen analysis — available through your OB-GYN or primary care provider today — give you a real picture before you need it. That information shapes your next step, whether that's trying naturally, adjusting timing, or talking to a specialist.

ASRM Practice Committee · asrm.org

Your Baseline

What to test — and how to get it

For people with ovaries

  • AMH (anti-Müllerian hormone)Most reliable marker of ovarian reserve. Can be tested any time — doesn't vary by cycle day.
  • Day 3 FSH and estradiolTests ovarian response. Ordered on day 2–4 of your cycle.
  • LHEvaluated alongside FSH; important for PCOS screening.
  • TSH and prolactinThyroid and hormonal factors that affect ovulation and cycle regularity.
Modern FertilityEverlywellLetsGetChecked

At-home options

AMH values can vary between labs. Use at-home results to start the conversation, not to draw final conclusions.

For people with sperm

About 50% of fertility challenges involve sperm factors.

A semen analysis evaluates count, motility, and morphology. It's non-invasive, low-cost, and the single most informative first test. Per AUA/ASRM 2024 guidelines, two analyses — ideally a month apart — give the most accurate baseline.

Order it at the same time as the hormone panel — not as a follow-up if things don't work.
YO (FDA-cleared)Dadi KitFellow

At-home options

In-clinic: ~$50–200, often covered under diagnostic benefits

AUA/ASRM “Diagnosis and Treatment of Infertility in Men” 2020, amended 2024

Know your window — 6 days, not 2

Conception is only possible during a narrow window each cycle: the 5 days before ovulation plus ovulation day itself. The catch: ovulation doesn't happen on day 14. It occurs 12–16 days before your next period — which means a 35-day cycle ovulates around day 19–21, not day 14. A tracking app that assumes day 14 is giving you the wrong target.

ToolWhat it measuresCost

LH strips (OPKs)

LH surge 24–36 hrs before ovulation

~$20–40/cycle

Basal body temperature (BBT)

Temperature rise confirms ovulation occurred

~$15 thermometer

Cervical mucus monitoring

"Egg white" texture signals peak days

Free

Proov (PdG test)

Confirms successful ovulation via progesterone metabolite

~$30–45/cycle

Cycle tracking app

Pattern analysis over time (pair with OPKs or BBT)

Free–$15/mo

Pro tip: Use more than one. LH strips confirm the surge is coming; BBT confirms it happened. Combined, they give you the full picture.

Wilcox AJ et al., NEJM 1995 · ASRM Practice Bulletin on Ovulation Induction

Quick Reference

Fertility evaluation at a glance

TopicAt a glance

What to Know

Before you start trying

The ASRM clinical threshold — what it is and what it isn't

ASRM defines infertility as 12 months of regular, unprotected intercourse without conception for people under 35; 6 months for those 35–40; and recommends an immediate evaluation for people over 40. This definition exists for two reasons: it determines when a specialist referral is formally indicated, and it's the standard insurers use to gate treatment coverage.

Does apply to

  • Under 35, no known conditions, trying without success
  • 35–40, standard timeline guidance
  • Over 40: evaluation now, regardless of how long you've been trying

Does NOT apply if

  • Irregular or absent periods
  • PCOS, endometriosis, prior pelvic infections, fibroids
  • History of recurrent pregnancy loss
  • Partner with a known sperm concern
  • Solo parent planning conception
  • Same-sex couple planning conception

For any of the above, evaluation is appropriate now — not after a waiting period.

Your path forward

Fertility care isn't a waiting game. Start with clear baseline information, understand your unique timing, and know exactly when to bring that data to a specialist conversation.

Start here

Before you start trying

  • Request a formal evaluation — under 35 after 12 months, 35+ after 6 months, over 40 or any known condition: you're there.
  • Both partners get tested — hormone panel + semen analysis, concurrent. Don't sequence this. ~50% of challenges involve sperm.
  • Rule out timing before your appointment — ovulation is 12–16 days before your next period. LH strips confirm whether you've been hitting the window.
  • Come prepared — bring test results, cycle data, and a clear timeline of what you've tried and when.
Prep for your first specialist visit →

Your next steps

Find your starting point

Wherever you are right now, there is a clear next step. Choose the description that fits.

Path 01

I'm just starting to think about fertility

  • Request a Day 3 hormone panel from your OB-GYN or PCP
  • Explore at-home testing (Ro, Everlywell, LetsGetChecked)
  • Start tracking your cycle — Clue, Flo, Clearblue Digital
  • Read the "How it works" section before you need it
Start a baseline plan

Path 02

I've been trying and it hasn't worked

  • Request a formal evaluation — under 35 after 12 months, 35+ after 6 months, over 40 or any known condition: you're there.
  • Both partners get tested — hormone panel + semen analysis, concurrent. Don't sequence this. ~50% of challenges involve sperm.
  • Rule out timing before your appointment — ovulation is 12–16 days before your next period. LH strips confirm whether you've been hitting the window.
  • Come prepared — bring test results, cycle data, and a clear timeline of what you've tried and when.
Prep for your first specialist visit

Path 03

I have a diagnosis or known condition

  • Find an RE who specializes in your condition
  • Review PCOS, endometriosis, male factor, DOR guidance
  • Bring diagnosis docs and prior testing to your first RE visit
  • Ask: what's my most likely first-line treatment?
Find a specialist

Path 04

I'm a solo parent or in an LGBTQ+ family

  • Review inclusive pathways for your anatomy and goals
  • Understand parentage order and donor agreement requirements
  • Connect with Family Equality, Men Having Babies, Fertility for Colored Girls, or SMC
  • Ask REs about their experience with your family configuration
Build your family plan

Path 05

I need to understand my finances first

  • Call insurance with the six key coverage questions
  • Check HSA/FSA balance — fertility is eligible
  • Verify current grant application windows
  • Ask clinics about multi-cycle packages and med-savings programs
Build your cost plan

Path 06

I'm ready to start treatment

  • Map your path with your Peony Plan
  • Get a full itemized cost estimate before your cycle
  • Set up intermittent FMLA if applicable
  • Line up mental health support before you need it
Start your treatment plan

Section 8

Key resources

The organizations and tools most commonly referenced in fertility care. All verified as active and clinically or organizationally credible.

Clinical

ASRM

Clinical guidelines, patient education, provider directory, advocacy.

asrm.org

Clinical

ReproductiveFacts.org

ASRM's patient-facing education hub. Clear, evidence-based.

reproductivefacts.org

Clinical

SART

Clinic-level ART success rate data — use to compare clinics.

sart.org

Clinical · Tool

CDC ART Data + IVF Success Estimator

National and clinic-specific outcomes; personalized estimates.

cdc.gov/art

Clinical

ACOG

OB-GYN guidelines, PCOS, endometriosis, preconception care.

acog.org

Clinical

AUA

AUA/ASRM joint guidelines on male fertility evaluation and treatment.

auanet.org

Advocacy · Support

RESOLVE

Support groups, professional directory, insurance, grants, advocacy toolkit.

resolve.org

Community

Fertility for Colored Girls

Community, advocacy, and financial support for Black women and families.

fertilityforcoloredgirls.org

LGBTQ+

Family Equality

LGBTQ+ family-building advocacy, resources, and community.

familyequality.org

LGBTQ+

Men Having Babies

Community for gay and bisexual men pursuing surrogacy and donor conception.

menhavingbabies.org

Solo parents

Single Mothers by Choice

Community and resources for solo parents by choice.

singlemothersbychoice.org

Oncofertility

The Chick Mission

Fertility preservation support for young cancer patients.

thechickmission.org

Mental health

Postpartum Support International

Mental health support for pregnancy loss and perinatal issues.

postpartum.net

Grants

Baby Quest Foundation

Up to $15,000. Two cycles/year. Next deadline Sept 10, 2026.

babyquestfoundation.org

Grants

Tinina Q. Cade Foundation

Up to $10,000 for treatment or adoption; underserved families.

cadefoundation.org

Medication savings

EMD Serono · Fertility LifeLines

Up to 75% off GONAL-F, Cetrotide, Ovidrel for eligible patients.

fertilitysavings.com

Financing

Sunfish

Marketplace aggregating fertility financing options and grants.

joinsunfish.com

Grants

RESOLVE grant listings

Aggregated current scholarships and grants for fertility treatment.

resolve.org/learn/financial-resources

Workplace rights

EEOC

PWFA, ADA, and Pregnancy Discrimination Act.

eeoc.gov

Leave

DOL · FMLA

FMLA eligibility, employer obligations, employee rights.

dol.gov/agencies/whd/fmla

Tax

IRS Publication 502

Eligible medical expenses including IVF; HSA/FSA eligibility.

irs.gov/publications/p502

Policy

Congress.gov

Track status of active fertility-related legislation.

congress.gov